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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Ron Pies MD on September 2, 1999, at 13:54:45
Hello, Bob! Great website! I hope you are well since our APA meeting...I am writing to see if anyone out there has case vignettes of patients experiencing manic, psychotic, or other adverse neuropsychiatric reactions to over-the-counter "antidepressants", including but not limited to St. John's Wort, SAM-e, ma huang (ephedra), etc. I am collating cases for an article on this topic, and would cite any vignettes as a "personal communication" from the author, unless he/she did not wish to be cited. I can also be reached at PO Box 332, Bedford MA 01730---Thanks much! Best, Ron Pies MD (Tufts USM)
Posted by Yardena on September 2, 1999, at 14:31:02
In reply to over the counter antidepressants, posted by Ron Pies MD on September 2, 1999, at 13:54:45
Don't have info for you, but it is a good topic. The "informal" meds need to be studied.
Posted by Dr. Bob on September 3, 1999, at 3:09:42
In reply to over the counter antidepressants, posted by Ron Pies MD on September 2, 1999, at 13:54:45
> Hello, Bob! Great website! I hope you are well since our APA meeting...
Ron, what a surprise! That was fun at the APA. Good luck with this article. I like your creativity in case-finding. :-)
For those of you who don't know, Ron is the Expert at Mental Health InfoSource:
http://www.mhsource.com/expert.html
Take a look at his archives; talk about a ton of information!
Bob
Posted by Cindy on September 3, 1999, at 21:45:00
In reply to Re: over the counter antidepressants, posted by Dr. Bob on September 3, 1999, at 3:09:42
Ron, I tried St. John's wort 3x per day for about a month. It didn't seem to do anything. I didn't feel any less depressed nor did I have any adverse reactions.--Cindy
Posted by Dee on September 3, 1999, at 22:30:44
In reply to Re: over the counter antidepressants, posted by Cindy on September 3, 1999, at 21:45:00
Same with me... I was not on medication, & I tried St. John's wort - Started with 1 capsule x 3, increased gradually until I had to, at 6x3 admit that it has no effect. Didn't notice any worsening either, when I got off it. No adverse effects.
Posted by Bob (not Dr. ;^) on September 3, 1999, at 22:49:29
In reply to Re: over the counter antidepressants, posted by Cindy on September 3, 1999, at 21:45:00
I've got major depression and panic disorder to deal with. Prior to getting on psychopharms, I was going through a phase where my anxiety level was getting pretty crippling. My therapist (this was *very* early in my treatment with her, before it was apparent that I needed meds) she suggested Valerian to help me relax. Not only did it work really well, I started dreaming quite vividly (I rarely remember dreams, except for that period). The big problem was that after two-four weeks of taking it daily, it started giving me killer headaches.
In comes altmed#2. A friend who has MS and has been looking into all sorts of alternative meds, holistic treatments, and nutrition issues gave me some Melatonin. It didn't work as well as the Valerian, but it worked ... for about the same period of time, with the same end result.
I wound up taking either on an as-needed basis for a while until things calmed down for me.
Altmed#3 -- you HAVE to look into this one: SOD. Superoxide Dismutase. I got it from a alternative nutritionist who was big on enzymes. Most of the research I found on SOD at the time involved product extracted from animal sources (pigs' livers, I think). The one she had me on was a product called Prozyme, which is primarily SOD but has lots of other enzymes and other "good stuff" in it at miniscule levels. It's a product of Allergon AB (Pharmacia & Upjohn). There was some MD in California who was conducting a study taking people off of their anti-depressants and putting them on this stuff. The letter I received from him sounded more like a sales pitch for the stuff than a properly-controlled study. Well, I can't say that I noticed any difference while I was on the stuff. To make matters worse, the stuff cost something like 60-70 cents a pill! That was depressing in and of itself. 8^P
Posted by Dee on September 4, 1999, at 1:05:03
In reply to over the counter antidepressants, posted by Ron Pies MD on September 2, 1999, at 13:54:45
Like I said, I never experienced *any* effects on over the counter supplements. Only exception is melatonin. I does put me to sleep, but I experienced rapidly worsening depression when I was taking it. I cannot really say that is due to melatonin, I did have a triggering experience just before I started taking it.
I cannot really say if I was more depressed because I was taking melatonin, or if I was taking melatonin because I was depressed. Could be both. My personal experience is that once the depression is on advance, it triggers other things in my environment, which in turn trigger the depression - until this downward spiral becomes impossible to correct.
I used to take 9-12mg at bedtime (the package said 3mg. During that time I has some episodes severe enough for me to definitely stop taking melatonin just out of fear that it might trigger that again.
Dee
Posted by dove on September 4, 1999, at 10:09:38
In reply to Re: Melatonin worsening depression?, posted by Dee on September 4, 1999, at 1:05:03
I have had extremely bad reactions to SJW and so has my husband. I was angry, paranoid, anxious, thought I was losing my mind. My husband became aggressive and very angry, no enthusiasm or drive, listless and hopeless. Extreme lack of motivation and depression sprinkled with paranoia and anger were our reations to even small amounts (100mgs) of SJW.
We both struggle with depression, mine starting from childhood, his from adolescence. He is a programmer and the SJW did something to his mind that made him unable to program and took away all of his 'good' feelings. Those couple of weeks were from hell and I have only felt that bad a few times in my lifetime. My husband had suicidal thoughts for only the third time in his lifetime.
We also tried Inositol, 150mg, with results almost identical to SJW. Depression hitting full force, easily frustrated, no ambition, anger (me), aggressive behavior from my husband. I tried a double blind experiment, placebo vs Inositol, my husband was absolutely reacting to the Inositol. He felt psychotic and truly believed he might harm himself.
Now melatonin. I have a history of staying awake for days and then being over-tired for 7-8 days, and then the cycle repeats itself. Started taking .5 mg-1mg sublingual melatonin and those problems have ended. I don't believe it worsens my depression in any way and I am able to wake up in the morning.
My husband has to take 1mg per night for the same reasons, if he takes over that amount there is some residual drowsiness and depression. As long as we keep the amount minimal and receive the greatest benefits with very good results.
dove
p.s. I also had a very strange reaction to Verapamil, which was prescribed for migraines. Felt normal for the first time in my life.
Posted by Michael on September 4, 1999, at 21:49:42
In reply to Re: Melatonin worsening depression?, posted by Dee on September 4, 1999, at 1:05:03
> Like I said, I never experienced *any* effects on over the counter supplements. Only exception is melatonin. I does put me to sleep, but I experienced rapidly worsening depression when I was taking it. I cannot really say that is due to melatonin, I did have a triggering experience just before I started taking it.
> I cannot really say if I was more depressed because I was taking melatonin, or if I was taking melatonin because I was depressed. Could be both. My personal experience is that once the depression is on advance, it triggers other things in my environment, which in turn trigger the depression - until this downward spiral becomes impossible to correct.
> I used to take 9-12mg at bedtime (the package said 3mg. During that time I has some episodes severe enough for me to definitely stop taking melatonin just out of fear that it might trigger that again.
> DeeI also experienced depression on Melatonin, but it took me awhile to make the connection. Took 3 mg/day off and on for sleep. After depression recurred suddenly, I stopped the melatonin and I was fine.
Posted by fendel on September 5, 1999, at 23:05:01
In reply to Re: Melatonin worsening depression?, posted by Michael on September 4, 1999, at 21:49:42
I took melatonin once and really crashed--luckily there wasn't anything bad going on in my life that I could point to, so when I found myself crying for no reason, it didn't take long to pin it on the melatonin.
Posted by Ron Pies MD on September 6, 1999, at 15:24:21
In reply to Re: over the counter antidepressants, posted by Dr. Bob on September 3, 1999, at 3:09:42
> > Hello, Bob! Great website! I hope you are well since our APA meeting...
>
> Ron, what a surprise! That was fun at the APA. Good luck with this article. I like your creativity in case-finding. :-)
>
> For those of you who don't know, Ron is the Expert at Mental Health InfoSource:
>
> http://www.mhsource.com/expert.html
>
> Take a look at his archives; talk about a ton of information!
>
> Bob
Thanks for the notice, Bob. Thanks also to people who responded to my initial query. I am actually hoping that clinicians will let me know about cases they have seen in which DHEA, St. John's wort, or SAM-e led to an adverse event...Best, Ron Pies MD (Tufts USM)
Posted by BRS on September 6, 1999, at 21:55:57
In reply to over the counter antidepressants, posted by Ron Pies MD on September 2, 1999, at 13:54:45
> Hello, Bob! Great website! I hope you are well since our APA meeting...I am writing to see if anyone out there has case vignettes of patients experiencing manic, psychotic, or other adverse neuropsychiatric reactions to over-the-counter "antidepressants", including but not limited to St. John's Wort, SAM-e, ma huang (ephedra), etc. I am collating cases for an article on this topic, and would cite any vignettes as a "personal communication" from the author, unless he/she did not wish to be cited. I can also be reached at PO Box 332, Bedford MA 01730---Thanks much! Best, Ron Pies MD (Tufts USM)
I've heard that combining 5-htp with St. John's wort can lead to serotonin syndrome in specific cases of high doses. You also need to be careful of the herbs licorice and schizandra because they do have subtle effects on serotonin synthesis and can cause problems if used with pharmaceutical antidepressants. Sam-e is strange because it has been found that depressed individuals do have lower sam levels, but they are markedly increased after treatment with a pharmaceutical antidepressant, which leads me to believe that Sam isn't the cause of depression, but just a intermediary factor.
Posted by John on September 9, 1999, at 12:25:15
In reply to Re: over the counter antidepressants, posted by BRS on September 6, 1999, at 21:55:57
> > Hello, Bob! Great website! I hope you are well since our APA meeting...I am writing to see if anyone out there has case vignettes of patients experiencing manic, psychotic, or other adverse neuropsychiatric reactions to over-the-counter "antidepressants", including but not limited to St. John's Wort, SAM-e, ma huang (ephedra), etc. I am collating cases for an article on this topic, and would cite any vignettes as a "personal communication" from the author, unless he/she did not wish to be cited. I can also be reached at PO Box 332, Bedford MA 01730---Thanks much! Best, Ron Pies MD (Tufts USM)
>
> I've heard that combining 5-htp with St. John's wort can lead to serotonin syndrome in specific cases of high doses. You also need to be careful of the herbs licorice and schizandra because they do have subtle effects on serotonin synthesis and can cause problems if used with pharmaceutical antidepressants. Sam-e is strange because it has been found that depressed individuals do have lower sam levels, but they are markedly increased after treatment with a pharmaceutical antidepressant, which leads me to believe that Sam isn't the cause of depression, but just a intermediary factor.Hi, hope you're able to identify the specific compounds under which "adverse events" are anecdotally reported. I've tried strictly the formulations which are the patented compounds cited in the clinical research trials found in a Medline search. Notably, these are Ginkgo Biloba (EGb 761), brand name Ginkgoba (Pharmaton - division of Boehring-Ingleheim), Ginsana (GS-115, Pharmaton), SJW (LI-160 - Lictwer; WS-5572 Pharmaton). I would think the number of adverse events would be low with these heavily used compounds, as long as users are communicating with their physicians when taking concommitantly with other meds).
This is the end of the thread.
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